Patient education following vertebral fragility fracture: a scoping review

Vertebral fragility fracture (VFF) incidence is rising with significant associated patient and health service burden. Patient education is core to effective VFF management and thus the focus of this robust literature review. Eight studies met review inclusion criteria with the limited evidence and inconsistent approach to education post VFF illustrated.

The incidence of vertebral fragility fracture is rising, associated with osteoporosis among an ageing global population. Most VFFs are managed conservatively with patient education, a core element of conservative management. This review aims to identify and synthesise the available literature regarding healthcare professional (HCP)-led patient education post VFF.

This review was registered on OSF [25] and conducted in accordance with the Joanna Briggs Institute methodology [21] for scoping reviews and guided by the Arksey and O'Malley Framework [22], using five key stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data and (5) charting, collecting and summarising the data. Six databases (Pubmed, ERIC, Embase, Cinahl, APA PsychINFO and Cochrane) were searched for papers published (in English) from January 2008 to November 2023, using a clearly defined search strategy. Predefined inclusion/exclusion criteria were used for screening papers using Covidence software [26] and a minimum of two independent reviewers. Data were extracted from full-text articles which met the inclusion criteria, with narrative synthesis of findings. Reporting of results adhered to the PRISMA-Scoping review checklist.

Title and abstract screening was conducted for the 7177 retrieved studies. Of the 34 papers identified for full text review, 8 studies (from Canada, Norway, Sweden, China and the UK) met the scoping review inclusion criteria. These included four randomised controlled trials, one pilot RCT, one non RCT one retrospective analysis of data from patients with fragility fractures and one pre-post interventional study. Where specified in the papers, education providers were a mix of healthcare professionals (Physiotherapists, Nurses, Doctors, Dietitians, Occupational Therapists). Education was delivered in a variety of settings using verbal, written and visual communication media. The most common education topics were exercise, osteoporosis, nutrition and falls management. A diversity of outcome measures captured patient knowledge, quality of life, falls efficacy, physical function, balance and pain.

Findings of this review demonstrate the limited evidence and an inconsistent approach to education post VFF in terms of education topics, mode of delivery and outcome measures. A range of HCP disciplines deliver education. Research is critically needed to inform the development and delivery of effective, evidence-based education interventions for VFF management.